What is the compensatory power of remotely training visually impaired by providing them with sufficiently many - each other reinforcing - visual experiences to extend their limited visual field by an up to two magnitudes bigger imaginary mental map until they eventually can independently navigate most visually challenging interfaces without needing to read even a single word
Remotely training visually impaired computer users requires them to retain color patterns and relative locations of previously encountered control elements for up to 100 times larger imaginary mental maps to navigate complex interfaces despite objectively never seeing more an 1% of them at any given time. This is why self-studies cannot substitute for remote tutors.
Educators must be aware of this shortcoming. Inexperienced visually impaired computer users may initially need more time and training to quickly form mental position maps exceeding their objectively measure visual field by up to 100 times. Many visually impaired users are not consciously aware of this shortcoming. That is why remote software training options should be easily available to them. Software updates can severely distort their mental maps; hence, requiring remote retraining. It even took me a while to figure this out since initially I felt very retarded about being the only one severely struggling with learning new complex visually challenging computer applications on my own. This limitation causes many visually impaired to give up on their STEM education because of misconceiving themselves as too stupid and unfit. Since they generally did not encounter such problems in high school when learning less visually demanding programs on their own vs. the need explicitly offered remote training options. They must be made aware of their adaptive needs for much larger mental maps in their post-secondary education . They must understand that their need for remote training is not caused by lack of intelligence to boost their confidence about being able to succeed in their STEM studies despite feeling helpless at times in quickly handling complex software upgrades on their own. I myself was trapped many times by the misconception that – compared to the rest – I am simply too stupid for ever handling any computer application changes confidently and professionally on my own. Most visually impaired eventually surrender because nobody is aware of this challenge and can recommend remote training to eventually overcome accessibility barriers. That is why educators, rehabilitation professionals, disability counselors, computing service providers, IT professionals, capstone project, research and dissertation supervisors, vocational rehabilitation counselors, assistive technology instructors, network administrators, professors, instructors, computer hackathon facilitators, program directors, department chairs, note takers, in-class assistants, disability office stuff, tutors, parents, and job-trainers need to become sensitized to assist if they see their visually impaired students struggling frustrated desperately trying to figure out the best way of navigating visually challenging complex computer interfaces loosing confidence in their abilities since none of their non-handicapped peers encounters similar problems. The only reason why I am still a STEM student is because I tend to beg my readers for help if I cannot accomplish the same tasks on my computer with Zoomtext as everyone else. I feel that since its not my fault that I have been born legally blind due to genetic mutations rendering me Albino there is no need to feel bad about unavoidable additional challenges in handling quickly changing computer environments as professionally as my peers. Although this attitude served me well as a student, but what about on the job? For most jobs nobody has ever considered making remote training options readily available for visually impaired employees struggling with updates and new programs on their own. I only understood the dynamic and need for remote training when SAP’s Autism at Work Program required all its interns to use company laptops instead of PCs. On my PC I am still using Microsoft Office 2003. Unfortunately, on my SAP company laptop, there was only Office 2016. I was feeling insanely stupid because I could not even type during my first week at SAP’s Asperger’s Academy. The most embarrassing part was that despite me having at least twice as many formal advanced academic degrees as any other interns, I could not type, email or search the web. What kind of insane doctoral student am I that I faced so much more trouble learning to use my SAP laptop than any high school student? At SAP nobody told me about mind maps and remote training. I was very fortunate to have PJ training me remotely as a friend at SAP. I can understand why employers are so reluctant to hire me.
Who will train me remotely on my new job? Eventually, I may be able to figure out the most important tasks on my own because I am very determined but it will take me much more time than any other SAP intern. Although nobody at SAP doubts that I have all the desirable Asperger’s traits, because of which SAP invests a lot in its Asperger’s at Work Program and I was by far the most educated intern, I am unfortunately also the only intern, who SAP is not offering jobs. My SAP supervisors know about my strengths in conceptual, creative, innovative and strategic thinking. Unfortunately, my unmet need for ongoing remote training seems them to perceive me as a potential liability, who nobody wants to risk hiring. Most of my SAP job-trainers were very patient and kept going over as many times as I needed to finally develop a new expanded imaginary mental map of the icons on my SAP laptop. Unfortunately, I felt very stupid being the only PhD candidate in our Autism Academy, who needed assistance for the most simple computer tasks, e.g. logging into the SAP network, finding and opening the emails of my supervisors, finding and opening course material online, finding my files from yesterday, etc. It took me almost 2 weeks before I had perfected my imaginary mental mind map of my SAP laptop that I could work with it as efficiently as all the other interns. Although – despite feeling humiliated about my big unmet need for help to create a new mental map of my SAP laptop – I kept demanding assistance for reinforcing the visual input sufficiently many times until I went to sufficiently many visual repetitions for forming a reliable and detailed imaginary mental mind map based on which I could eventually navigate and operate my SAP laptop without needing any more repetitive visual input experiences. Unfortunately, we had to learn lots of new SAP programs. I had to struggle with every single one of them. However, the fact that it never took me more than 2 weeks to update my mind maps frequently enough for using any new and initially visually intimidating program faster than anyone else, because of my superior typing speed, boosted my confidence – despite all of the initially humiliating struggle – eventually I possess all needed cogitative, visual, mental, physiological and conceptual prerequisites needed for remaining hopeful to eventually succeed in convincing flexible employers from the huge potential benefits to hire me and working with me on composing a set of job-responsibilities only for me, which I can take care of much better than anyone else. Unfortunately, SAP is not ready to consider shifting my job responsibilities around until I am the most qualified applicant for a very specific custom-made job specifically composed only of tasks tailored to my strengths, gifts, passions and talents, but completely free of tasks, which could cause my disabilities to get in the way of completing them better than any of my genetically superior Wild Type (WT) job-competitors.
My main motivation for investing so much time in describing my insights in such detail is that my student status will be taken away way too soon. This would prevent me from sharing and publishing my still not yet shared insights. This would have exactly the same overall effect as if I’d never studied in America for over 17 years. Unfortunately, many of the things I have learned and insights I gained are outside the strict scope of my academic training. But exactly that makes them so valuable because my unique experiences as a misunderstood disabled STEM student, my intuitive understanding of them and their potential benefits and my passion for writing them down hoping for at least one person on this planet to discover, understanding and implement my writings. I am not aware of anyone else, who I feel can write as passionately and convincingly about the topics, which appear to me of upmost importance while I am writing about them.
Its kind of amazing that navigating through such kind of imaginary visual memory, which - although initially requiring visual input from the very small effectively remaining visual field for initially creating the necessary visual memories and experiences for gradually developing a functional imaginary model of the remembered relative spatial relationships between the objects encountered when scrolling the screen with the effectively remaining very small but realistically existing visual field - no longer requires functional eyesight to complete the same tasks, for which normally the realistically existing and effectively remaining very small visual field would be otherwise needed, as long as reality is not changing after the imaginary model was created from its memories.
That is why I hate companies, journals and other entities for changing the layout of their websites and interfaces just to look trendy and modern because this instantly inevitably renders all my imaginary visual memories, on which I am heavily depending to re-expand the narrow boundaries of my effectively remaining very small visual field, which took so much efforts, time and many repetitions until a functionally usable imaginary model of the relative spatial relationships between the objects encountered with the very small effectively remaining visual field could gradually develop, as utterly useless over night because suddenly it would be better if these now false imaginary models would have never been created in the first place.
I just wanted to tell that theoretically, I can still learn almost every - no matter how complex - task on computer as long as I can find people, who patiently assist me in creating a functional model of the things I saw in reality in my imaginary visual memory by patiently practicing with me until I can perform all its functions on my own.
Repetitive visual memories are absolutely essential for expanding the imaginary visual field up to 100 times as prerequisites for remotely training visually impaired scientists in navigating complex program interfaces independently despite objectively visually seeing less than 1% of the new program control elements.
Applying this concept to remote train visually impaired has worked beautifully for Anna Ross from the University of Washington in Seattle to train me remotely navigate and use my smart phone, despite not being able to read it, because she provided me with the needed visual input experiences, based on which I could form a mind map of my smart phone, which solely consists only of color patterns, sufficient to use it without needing to clearly see it. Hence, everything I have described about remote computer training can be applied to remote smart phone training as well. This is important because it is a way to foster inclusion, overcome isolation and discrimination because I need to use a smart phone to order Uber rides. Since there are many smart phone apps lacking their PC counterparts resulting in excluding anyone, who cannot use a smart phone, from the many activities and services, for which only smart phone apps, but no equivalent PC programs, are available. The screen of most smart phones can be shared by installing the TeamViewer app via PlayStore. Even in cases where true remote control by smart phones or PC is not available, it is possible to share smart phone screens between trainer and visually impaired trainee. As long as trainer and trainee can see the same thing, e.g. color pattern, the trainee is free for as many repetitive visual input experiences and smart phone apps operation steps as needed to form a new smart phone mind map allowing smart phone usages by most visually impaired even if they cannot read their smart phone.
According to my experiences as a visually impaired power user it is much easier to learn a new application by remote training instead of following spoken or written instructions of tutorials. Since the remaining visual field of many visually impaired is simply too small to cover tutorial texts and its applications, its much easier for visually impaired trainees to watch the steps o their remote trainers with their Zoomtext to learn about new applications much better than when being limited to its written tutorial.
Although sighted computer users can see written tutorials and the described software applications simultaneously, they could definitely learn much faster by getting remotely trained as well. Since the sighted have a way to learn most new programs on their own they don’t tend to demand remote training. However, the observation that what’s helping the visual impaired would also help the sighted still holds true, because even the sighted could save a lot of time and avoid a lot of struggle and ambiguities, if they could be trained remotely by experts in any procedure, analysis and methods, which they are trying to learn.
Optimizing Power Wheelchair Use Through Mobility Training :-
Driving a power wheelchair may appear to be a simple task. In reality, independent driving requires specific motor, visual, and cognitive skills. These skills are assessed during the power mobility evaluation
Device Training
Before starting driving lessons, basic power wheelchair training is imperative. This includes care and maintenance of the wheelchair, as well as basic operating instructions. A power wheelchair may be quite intimidating to the client and/or caregivers. Providing basic instructions decreases this anxiety. Providing written instructions for future reference is very helpful as well.
The authors of this article recommend that any training be documented and any written instructions be copied and filed. If written instructions are lost, these can be retrieved and provided again. Documenting training can also limit liability.
Cognitive Training
Some clients will hop into a power wheelchair and take off, requiring no training at all. Other clients may require extensive and long-term training, particularly if the client has a slow learning curve. Children, in general, respond better to minimal instructions using simple and consistent vocabulary. Learning through trial and error while driving in quiet, large spaces is often most effective. Just as a teen doesn’t begin by driving on the freeway, a new power wheelchair driver needs to begin in large, quiet environments, and gradually move to areas that require more accuracy and contain more distractions.
Using a power wheelchair requires mobility concepts such as cause/effect, stop/go, directional, problem solving, and judgment. Before a power wheelchair is recommended, the client will typically demonstrate at a minimum cause/effect and stop/go concepts.
Cause and effect, in power mobility, is recognizing that an action (such as pressing a switch) leads to a result (movement of the wheelchair). This concept is typically obvious as a facial response to movement. Before equipment recommendation (pre-mobility training), cause and effect can be developed using switch toys and other activities such as single-switch software and tablet apps.
Stop and go concepts are one step above cause and effect. The driver recognizes that one action (such as pressing a switch) results in moving and another action (such as switch release) results in stopping. At this point, the client may not stop accurately, but does understand the concept. To develop accuracy in stopping, the trainer may ask the client to drive to a specific destination (drive to the table) and stop before collision. When training children, games such as Red Light, Green Light can be employed and are especially effective when involving peers.
Directional concepts are the understanding that moving the joystick in a certain direction will move the wheelchair in the corresponding direction, or that pressing one switch will move the wheelchair in one direction while pressing another switch moves the wheelchair in a different direction. Conceptually, this does not mean that the client can drive accurately yet. To develop the client’s ability to apply these concepts to driving, the trainer may ask the client to drive to a specific location (drive to the table), which requires the client to choose the correct joystick movement or directional switch. Placing motivating objects at the destination may help. A game that reinforces this skill in children is Follow the Leader.
Problem solving requires the client to combine and time joystick movements or switch activations to get from one location to another. Many clients require practice to develop accurate and efficient driving. The client may initially take “the long way” from point A to point B, but with continued practice, accuracy improves and time required to move between locations decreases. The trainer may choose a location that requires a combination of joystick movements or switch activations and encourage the client to drive there. For children, playing Hide and Seek is a great way to train this skill.
Judgment is difficult to measure and to train. Many of the clients we work with have impaired judgment due to lack of experience. We learn the consequences of our actions through experience and then develop judgement as a result. For example—taking the perspective of a child—if I run into my friend on the playground it hurts us both, and I remember that in the future. If my wheelchair runs into another child, however, this may not hurt me and therefore I may have difficulty understanding why it hurts the child.
In general, it is helpful for the trainer to remain positive, calm, and patient. If the trainer is anxious, the client may become anxious. Many clients need time to process commands, and so the trainer should use simple instructions and then wait—giving the client time to process and act on the command rather than having to process a string of commands given by multiple people.
Motor Training
Extensive motor repetitions are required to develop a motor pattern to the point of automaticity. When a movement becomes automatic, one reacts without thinking. For example, a ball bounces across the street in front of your car, and your foot is on the brake. You didn’t think about where the brake is, where your foot was, and what you needed to do—you only thought, “stop!” We ultimately want a client to think of where they want to drive the power wheelchair, not how to drive. The clients we work with may require extensive driving practice to develop this automaticity.
Before a power wheelchair recommendation, a variety of motor activities, such as playing with switch toys, can be used to develop the ability to press and hold a switch. Driving a power wheelchair requires sustained contact with the joystick or a switch, as opposed to other assistive technologies that may only require a momentary switch contact. After power wheelchair delivery, training is most effective in the wheelchair.
Programming
Programming a power wheelchair customizes driving parameters to the client’s needs and abilities. During training, further programming may be required to optimize driving. As the client improves, overall speed and responsiveness may be increased to match the client’s increased competence.
Recently introduced to the mobility market are alternative drive control systems that combine advanced programming and hardware to optimize operation. Among these devices are systems designed for convenient “plug and play” installation, and built to be compatible with wheelchairs offered by a variety of manufacturers. These include systems built around a central processing unit and designed for use with a head array, sip and puff, joysticks, tray arrays—or combinations such as joystick and head array, or sip and puff/tray array. A tablet device can be used to program commands for these alternative drive control systems to make a range of detailed adjustments with the aim of creating smooth and responsive operation.
Tracking
Tracking technologies are optional on complex rehab power wheelchairs and increase efficiency in driving by reducing the amount of joystick movements and switch activations required to drive from one location to another. Tracking keeps the chair “on track,” reducing compensatory movements required to remain on course. For example, if a client is driving down the sidewalk and crosses a driveway, many wheelchairs will drift downward on this slope. Now, the client has to compensate for this course deviation with additional joystick movements or switch activations to correct their course. With tracking, the chair will maintain a straight course despite changes in slope. Competent joystick drivers will make these compensatory movements while driving and may not require tracking technologies, but this feature can be especially valuable for switch drivers. An informal study demonstrated a significant reduction in the amount of required switch activations and time to complete a course when tracking was enabled.1
Just as power mobility training optimizes power wheelchair driving, programming and tracking technologies do as well. When recommending a power wheelchair, tracking technologies should be considered, particularly for switch drivers.
Drive Wheel Configuration
Power wheelchairs are available in three drive wheel configurations: front, center, and rear. Each configuration drives differently, and specific training can optimize navigation. An example is turning a corner. When driving a rear-wheel-drive power wheelchair, the driver will need to make a wide turn to clear the front end of the wheelchair. Therefore, if the client is driving down a hallway and turning into a doorway on the right side, a rear-wheel-drive chair may need to be on the left side of the hall to complete the turn. When driving a front-wheel-drive configuration, the driver would stay on the right side of the hallway to make a 90-degree turn into that doorway to clear the rear end of the wheelchair. A center or mid-wheel power wheelchair clears the doorway best when turning from the middle of the hallway. The client may benefit from specific training to navigate the environment in a particular drive wheel configuration in addition to standard mobility training.
Training Tools
Training resources are available that provide more detailed suggestions, including guides for pre-mobility and mobility training, and powered wheelchair training guides. Some resources are available for purchase, and others are offered at no charge.
A favorite training tool among some therapists is the Remote Stop Switch. This allows the trainer to stop the power wheelchair from a distance by pressing a button, freeing the trainer to stand away from the client, encouraging him to drive while observing how he is doing. A Remote Stop App is pending from one wheelchair accessory manufacturer for use on a smartphone. Funding is challenging for Remote Stop Switches, but this App reportedly will be priced affordably.
Team Approach
A coordinated, team approach to mobility training is essential in facilitating optimal functional outcomes for the prospective driver with significant cognitive or motor impairment; and is key in avoiding the potential for equipment abandonment. This requires a common understanding and collaborative planning among team members. Issues that should be discussed include:
1) Duration, frequency, and limitations of skilled mobility training anticipated for the client.
2) Functionally relevant training environments and any potential restrictions surrounding service provision. For example, under some health plans, the clinician cannot bill for services outside of the clinic. The health plan may also limit the number of visits.
3) Client and caregiver responsibilities in the mobility training process (ie, home program).
4) The delineation of roles and responsibilities in the training process between clinician, supplier, caregiver, and client.
While mobility training is a shared responsibility, the clinician assumes primary responsibility for leading the process. Utilizing a combination of standardized assessments and clinical judgment, the clinician formulates and implements a graded plan for mobility training tailored to the client’s unique set of needs.
Assessment and treatment surrounding mobility needs are considered to be a billable service for both occupational and physical therapists under most health plan rules. These interventions are billed under a unique set of CPT codes, and the clinician must further understand the specifics of the individual health plan’s rules and limitations surrounding Mobility Assessment and Training in the context of formulating an optimal treatment plan.
The treatment plan will typically include instruction in, and monitoring of, a supervised home mobility training program to be implemented by the client and caregiver. This component is essential for success given the restrictions imposed on therapy services by many of today’s health plans. Due to restrictions in the number of skilled visits allowed, the caregiver and client frequently carry a significant amount of responsibility for the ultimate mobility outcome.
The power wheelchair supplier also has an integral role in the mobility training process. While not a billable service for the supplier, the responsibility for helping the client to achieve their mobility goals is equally shared. RM
Michelle L. Lange, OTR/L, ABDA, ATP/SMS, has more than 25 years of experience and is former clinical director of The Assistive Technology Clinics of The Children’s Hospital of Denver. She lectures globally, and has authored six book chapters and nearly 200 articles. She is editor of Fundamentals in Assistive Technology, 4th ed, and clinical editor of NRRTS Directions.
Eric Grieb, ATP, CRTS, OTR/L, earned a BS in occupational therapy from Colorado State University in 1992. He has worked in the clinical subspecialty of Seating and Wheeled Mobility for the last 20 years as a clinician and supplier of complex rehabilitation technology. For more information, [email protected].
Reference
1. Brown L, Lange M. (June 2013) Tracking Technologies: a Phase 1 Study to Validate Efficiency. In Mobility Management. 2013;(June): 24-25. A summary of these results can also be found at www.atilange.com under Resources.
In this study, the aim is to determine the opinions of special education students regarding the use of distance education system for individuals with hearing, visual and physical disabilities. The qualitative research method was used in the research and the interview questions utilized were developed by the researchers. A total of 40 students enrolled in the teaching program for the mentally disadvantaged, the special education graduate program and the special education doctorate program participated during the 2015-2016 autumn semester. The answers given by the students to the interview questions developed by the trainer were examined by taking expert opinions and the obtained results were interpreted using an induction technique. According to the findings obtained from the research, it was found that distance education systems have advantages such as ease of access, 24-hour availability and life-long training without dependence on a particular time and place. Furthermore, the findings indicate that distance education certificate programs can also provide employment opportunities to individuals with these disabilities. Additionally, certificate programs can be provided to individuals with vision impairment on call center operations, interpreting and online trainee certification programs, among others. For individuals with hearing impairment, certification can be offered in areas such sign language instruction, graphic design and web design and programming. In terms of certificate programs for individuals with physical disabilities, programs can be designed for interviewer training, e-marketing, call center operations, etc.
As a visually impaired person with a good level of computer skills in many programs, I suggest your focus is neoliberal and very ‘medical model’ based; if you change your focus you may advance your research further. I suggest you read texts that discuss the medical model versus the social model because the medical model has pretty much been discarded by disability scholars these days. The classic social model has also been superseded but getting a grasp of the social model will help you reframe your questions. You’d also be less likely to offend vision impaired people.
I recommend you read Disabilily and Discourse Analysis by Jan Grue, then branch out and read some of the texts he cites, particularly the ones like I think it was Oliver who changed the wording of research questions directed at disabled people. The original questions placed the locus of responsibility for problems within individuals and their impairments. The new questions were actually aimed at diagnosing solvable problems. For example, instead of asking how their disabilities made it difficult to open jars, the new questions asked how poor technological design makes it difficult to open jars.
I think you’ll find the problems vision impaired people encounter in STEM studies have very little to do with their disabilities and desire to learn and far more to do with institutions and barriers to participation.
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